Transforming healthcare

Posted on 18 Jan 2013 at 9:15am

LGBT advocates in Dallas, Fort Worth push for cities to provide comprehensive insurance coverage to transgender employees

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TAKING THE INITIATIVE | Nell Gaither, a former city employee who is president of Trans Pride Initiative, started a campaign in December to persuade the city to add comprehensive transgender health benefits in 2014. But City Manager Mary Suhm recently told Gaither that isn’t going to happen. (Anna Waugh/Dallas Voice)

ANNA WAUGH  |  Staff Writer

When Dallas police officer Debbie Grabowski transitioned six years ago, she paid for the $90,000 in surgical procedures out of her own pocket because the city’s health insurance didn’t cover gender reassignment surgery.

Officials say the city’s coverage includes everything except the surgery, including hormone replacement therapy, but Grabowski said the plan doesn’t currently cover her hormones — and never has.

“It hasn’t changed,” she said of the city’s healthcare coverage. “If it did change, I’m not aware of it.”

Grabowski also said her gender marker hasn’t been corrected in the city’s directory despite several attempts to get it changed from male to female. She’s also put off getting male wellness checkups because she doesn’t think they’d be covered.

If the city had covered her surgeries, Grabowski said it would’ve helped immensely.

The issue is even worse in Fort Worth because Cowtown’s insurance plan specifically excludes everything related to transgender care.

Transgender-inclusive healthcare is rare among cities nationwide, with only five out of 137 cities ranked in the new Human Rights Campaign’s Municipal Equality Index listed as having the coverage — San Francisco, Minneapolis, New York, Portland and Seattle. But more and more cities and private companies have started offering the coverage since San Francisco became the first U.S. city to cover gender reassignment surgery for its employees in 2001.

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NOT-SO-SMOOTH TRANSITION | Dallas police officer Debbie Grabowski, shown at work in 2007, was forced to pay $90,000 out of pocket for gender reassignment surgeries. Grabowski claims her hormone therapy isn’t covered, either, but city officials insist that it is. (John Wright/Dallas Voice)

Deena Fidas, deputy director of HRC’s Workplace Project, said trans health benefits are medically necessary and help people complete their gender transitions. She compared a trans person who is denied hormone therapy coverage to a woman going through menopause who is able to get hormone replacement therapy, as one example of the inequity.

“What we’re dealing with are medically necessary therapies, surgeries and procedures, and so the denial of the insurance coverage is just as critical as somebody who’s not transgender being denied coverage for needed endocrinology appointments or needed surgeries,” Fidas said. “It’s incomplete healthcare coverage to not extend these benefits to transgender employees.”

Fidas said companies are increasingly offering them after HRC began requiring trans-inclusive healthcare for companies to receive a perfect score on its Corporate Equality Index. The number of companies that offer the benefits has since grown from 49 in 2009 to 287 at end of 2012.

California and Oregon recently mandated that private insurance companies stop discriminating against people based on gender identity.

Without specifying medical treatments that are covered, companies must cover hormone therapy, breast reduction and medical screenings if they would cover it for patients who are not transgender.

When the city of Portland added trans-inclusive healthcare coverage in 2011, the cost increase was $32,300 added to its $41.6 million healthcare budget. Portland has roughly 9,000 employees.

Trans advocates said many cities see little or no financial impact as there are few people who access the coverage. Fort Worth has roughly 6,000 employees and Dallas has about 13,000.

LGBT leaders in North Texas are hoping the national attention to the issue will help them conquer fears and attitudes locally to offer comprehensive trans health benefits by year’s end.

Nell Gaither, president of Trans Pride Initiative, started a campaign in December to persuade the city of Dallas to add comprehensive coverage to its 2014 budget.

City Manager Mary Suhm was asked about adding the benefits at a city June Pride event. Suhm said the money wasn’t there to add them and encouraged people in attendance to continue to remind council members they were needed.

Suhm also said at the event that the upcoming budget year may be more favorable for including more health benefits, so Gaither said she hopes the city will find a way to add them.

“I think we’ve all been thinking about it for a while but haven’t gone anywhere with it because of the budget,” Gaither said. “I think this is an issue that a lot of people don’t know is a problem.”

Suhm told Dallas Voice that the city’s current UnitedHealthcare plan covers everything the trans community needs except gender reassignment surgery. She said employees who speak about the plan should be clear about what it covers.

“Our plans need to be clear about that and the people that are answering those questions need to understand. …I don’t want it to be difficult or people to feel intimidated about getting them [the services],” Suhm said.

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CHEERS AND JEERS  | Fort Worth employee Tori Van Fleet applauded when trans discrimination protections passed in 2009, but she criticized officials for failing to add trans health coverage despite the recommendation of a Diversity Task Force following the Rainbow Lounge raid. (Dallas Voice file photo)

According to a copy of the city’s healthcare plan, “sex transformation operations” are not covered. UnitedHealthcare’s prescription drug plan is separate. CVS/Caremark is the current prescription provider and doesn’t list hormone replacement therapy in its exclusions.

Gaither worked for the city for more than five years before quitting last June to dedicate more time to her nonprofit. She said her hormones were sometimes covered based on the prescription provider, adding that Caremark covered her hormones.

Asked about Grabowski’s statements, Suhm insisted hormones are covered under the city’s plan and that the people processing claims needed to be aware of the coverage.

“Those things are covered. We need to work harder on the training and on the clarification in the material, but then again if people have a problem, we need to hear about it,” she said.

Frank Librio, director of the city’s public information office, issued a statement saying that the city doesn’t cover surgery related to gender reassignment, but it does cover wellness exams and “other health services.”

“If there are problems with coverage because of gender markers, the city will address such situations on a case-by-case basis to ensure that the medically necessary coverage the member is entitled to is provided regardless of their gender marker,” the statement read in part. “Based on feedback from the community we now recognize that our documentation and communication of this is not as clear as it needs to be and will work to clarify this going forward.”

Gaither created letter templates for people to send to city council members, Suhm and Mayor Mike Rawlings to urge them to extend coverage for trans employees. She also started a Change.org petition entitled “Provide Equal Access to Health Coverage for City of Dallas Employees.” So far, 57 people have signed the petition.

Gaither postponed the letter aspect of the campaign after she attended a meeting of Councilwoman Delia Jasso’s LGBT Task Force on Jan. 9.

Transgender-inclusive healthcare was on the agenda and Gaither attended to approach the Task Force about helping with her campaign. At the meeting, Suhm spoke about the coverage and said it was unlikely gender reassignment surgery would be added to the budget this year. Suhm agreed to meet with Gaither and the city’s benefits coordinator to discuss the city’s coverage at the end of January.

Despite the upcoming meeting, Gaither said she will continue her work to eventually get the surgery covered.

“I’d love to see full surgeries covered, but Mary Suhm’s already said that that would not happen,” she said.

As for including the surgery in the coverage, Suhm told Dallas Voice it would be an issue for the budget, which staff will begin working on in about a month.

“It would be a plan that would be approved by the City Council,” she said. “It’s a process.”

When asked whether she supports adding the coverage or if she would place it in her proposed budget, Suhm said: “I can’t support things.

That’s not my role and I don’t know anything about the budget just yet, so we’ll have to work through that as I go through the budget process.

“It could be a part of the budget, but I don’t know whether it can be a part of this year or not,” Suhm said. “The staff brings a recommended budget to the council and so if there’s a way to do that in that context, it could [be a part of the budget].”

When Rawlings was asked whether he supported offering trans health benefits in a May 2011 mayoral runoff forum, he said he thought the surgery was an elective procedure, adding that he didn’t have enough information to speak decisively on the matter.

Paula Blackmon, Rawlings’ chief of staff, said in an email this week, “Because employee insurance is an issue the city manager handles he will await her direction.”

When Jasso was asked whether the LGBT Task Force would take up the issue, her assistant Gary Sanchez emailed that city staff is planning to meet with representatives with Trans Pride Initiative.

Pam Gerber, a member of the LGBT Task Force, said she was glad Suhm was at the meeting to explain the city’s coverage. As for having the city cover the surgery, she said she’s not informed enough to give an opinion but thinks the city should research the issue.

“I think it certainly deserves having the city look further into it and ultimately come up with a solution where everyone can win,” Gerber said.

In Fort Worth, comprehensive trans healthcare has been on the backburner since 2009, when it was the only outstanding recommendation of 21 suggestions from the city’s Diversity Task Force that was created in response to the raid on the Rainbow Lounge.

Tori Van Fleet, a city employee who served on the Task Force, said she remembers a council member stating that the benefits wouldn’t pass because voting in favor of them would be a political risk.

“I think it should’ve been added back then, but too many people were afraid of it and against it,” she said.

Fleet, who is now a board member for the city’s LGBT advocacy group Fairness Fort Worth, said the group’s former President Thomas Anable was working on a plan to add the benefits last year. However, after a board meeting Jan. 10, she said the group will have to start all over because members are unsure where Anable left off. She said the plan of action will avoid a vote from City Council and would add the benefits by the end of the year.

Fleet transitioned in 2008 and paid for the surgeries on her own. Although Fort Worth’s Aetna plan specifically excludes coverage for “sex change surgery or treatment of gender identity disorders,” Fleet was able to get her hormones covered because her doctor prescribed them for a hormone imbalance. She worries about getting wellness exams now that she is listed as female.

“My understanding is I would have to fight to get [those checkups] done,” she said. “It’s really sad that the city doesn’t cover it because we should be entitled to the same care. We are paying for coverage and therefore we should get total coverage.”

Oliver Blumer, regional director for Transgender Education Network of Texas and a member of Jasso’s LGBT Task Force, said the fact that the city covers counseling and hormones is an accomplishment in itself.

“Hormone replacement therapy and therapy both [being] covered is huge,” Blumer said. “Across the country that’s huge.”

Blumer said more can still be offered and the specifics of the current plan should be better communicated.

“My understanding was that the Task Force would begin to look into this and see how in collaboration with other groups we could take this to the city at the appropriate time,” he said.“You can say you’re diverse and inclusive, but they [city officials] have no idea about anything about the culture and the clinical competency that surrounds [transitioning].”

This article appeared in the Dallas Voice print edition January 18, 2013.

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